Laraniya case: Somewhere, somebody missed something

What to do , the Public hospitals are underfunded ,short on medicines , test kits , medical staff , beds , equipment , parking and demoralized hospital staff. Hospital staff who forgot their Hippocrates oath and dispense treatment according to racial and religious preferences, not all but enough to see that there is discrimination when dispensing treatments and medicines. Most glaring in the emergency and the wards

Laraniya case: Somewhere, somebody missed something

Last Updated 17th April, 2017, 5:00 PM

Pediatric intensivist Dr Ng Gee Sang says high fever in young children that persists for more than three days should not be overlooked

KUALA LUMPUR: Pediatric intensivist Dr Ng Gee Sang said today that young children with bouts of high fever that lasts for more than three days should be treated more seriously than be dismissed as ‘normal’ fever.

He however admitted that there are no “hard and fast rules” when it comes to admitting sick children to hospitals.

“We usually ward them (children) if we suspect something other than normal fever and flu but actually there is no hard and fast rules (when it comes to admitting sick children).

“When we come across kids with fever, flu or cough, we are not so worried but vomiting and diarrhea alerts to something more,” said the pediatrician of 22 years.

He added that the doctors would be worried if the condition does not improve in two to three days, with the fever persisting together with diarrhea and vomiting.

“We will be more worried. It still depends on the actual clinic presentation (whether to admit to a ward or not). But there are no specific guidelines.”

Ng said that the younger the child, the more doctors have to be cautious when treating them.

He opined that in the case of four-year old Laraniya Wilbert who died a week after a prolonged fever, it could be a case of “somewhere, somebody missing something” from March 14 when she was first brought to Taman Botanik government clinic, to when she died on March 20 in the intensive care unit of Tengku Ampuan Rahimah Hospital in Klang.

Ng said that the girl’s guardians should have gone to other hospitals since the ones they went to refused to ward the girl even though she had a fever of 41 degrees continuously for a week.

“[…] then look for other hospitals. What else can you do since this hospital doesn’t accept (to ward her)? Maybe somewhere, somebody missed something… must be something missed,” opined Ng who is a private practitioner.

When commenting on the case, Deputy Director General of Health (Medical) Dr Jeyaindran Sinnadurai recently told Berita Daily that there are certain guidelines on when to admit sick children that may have been overlooked in Laraniya’s case.

“I think there are certain guidelines, I wouldn’t be able to comment, on management of children which was brought up by pediatricians. They would be able to tell you of the guidelines, or at what level do you admit a kid.

“There are certain judgment calls that need to be made. I do not know why these guidelines were not followed. That has to be looked into and I think the external inquiry should have done so, it might be in their report,” said Jeyaindran.

From normal fever to death

It was previously reported that Laraniya was first taken to the Taman Botanik clinic on March 14 by her mother P Prem Sri for having a fever of more than 40 degrees, but instead of warding Laraniya, the doctor conducted a blood test and sent her home with medication, saying it was a “normal fever”.

Prem Sri was asked to bring the child on the following day to test if Laraniya’s fever was due to dengue, which she complied with.

On March 15, Prem Sri took Laraniya, who still had high fever, to the same clinic, where a dengue test was done.

Those responsible took another blood test and sent the child home, suggesting that they bathe her every two hours.

The distraught mother did as she was told, bathing her four-year old every two hours and feeding her medication every six-hours.

On March 16, Laraniya’s condition was no better and Prem Sri took her again to see the medical experts in the same clinic, where the doctor checked and told her to continue with the previous medication given.

According to Prem Sri, the whole of March 17 Laraniya was at home barely eating anything and vomiting whatever little she was fed.

On the 18th, Laraniya was very weak according to her mother, therefore she was taken to the Tengku Ampuan Rahimah hospital where once again she was sent back after more blood tests that came up ‘fine’.

Prem Sri pleaded with the hospital to ward Laraniya and keep her under observation but was refused, so she went home and kept giving her child the medicines prescribed by the hospital.

By March 20 Prem Sri decided to take her child to a private clinic where they were told Laraniya needed to be put on drips as she was extremely weak battling a high fever since March 14.

Unfortunately, the private clinic was not equipped to give Laraniya the treatment she direly needed. The private clinic doctor wrote a referral letter to the Tengku Ampuan Rahimah hospital and the family rushed Laraniya there.

The family raced the sick child to the hospital in 20 minutes and Laraniya was taken to the critical unit where she breathed her last, according to Prem Sri.

Four days after the child’s death, on March 24 HTAR director Dr Ding Lay Ming said in a statement that the child was brought to the hospital lifeless.